Dr. Hillengass on Imaging Modalities in Multiple Myeloma

Jens Hillengass, MD, professor of oncology and internal medicine, chief of myeloma, Roswell Park Comprehensive Cancer Center, professor of medicine, Division of Hematology and Oncology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, discusses available imaging modalities in multiple myeloma.

Historically, a skeletal survey using a conventional X-ray was widely used to assess bone disease, says Hillengass. However, whole body low­­­-dose CT scans are used more frequently now due to their increased sensitivity.

Patients who undergo low-dose CT scans are exposed to a slightly higher amount of radiation versus those who undergo X-rays, says Hillengass. However, since low-dose CT scans can identify 25% more patients with bone disease, it is the standard bone-imaging modality in multiple myeloma.

MRI has historically been used to see bone marrow detection before the bone marrow is destroyed. Though MRI can identify osteolytic lesions, it cannot reveal whether lesions are active or not, says Hillengass.

Instead, PET/CT scans, which can show disease metabolism, tumor burden, tumor activity, and bone marrow destruction, should be used. Depending on the sensitivity of the PET/CT scan, focal infiltrations and bone healing may also be seen with this imaging modality, concludes Hillengass.